脑卒中及其危险因素与小而密低密度脂蛋白关系的研究

目的探讨血浆小而密低密度脂蛋白（sdLDL）与脑卒中及其他危险因素的关系。方法采用全自动生化分析仪检测112例脑卒中患者的血浆sdLDL水平,患者均经头颅CT和核磁共振检查证实脑卒中,其中缺血性脑梗死54例,腔隙性脑梗死32例,脑出血26例。对照组120例,性别、年龄匹配并经严格检查排除了脑卒中。观察各组间sdLDL的变化及其与预后的关系,对sdLDL的影响因素采用多元逐步回归进行分析。结果缺血性脑梗死组和腔隙性脑梗死组的血浆sdLDL水平为（1.65±0.31）mmol/L和（1.13±0.21）mmol/L明显高于对照组（0.39±0.14）mmol/L（P〈0.01）;脑出血组的血浆sdLDL水平（0.48±0.19）mmol/L与对照组比较差异无统计学意义（P〉0.05）。多元逐步回归分析显示,危险因素中的甘油三酯、年龄、收缩压、高密度脂蛋白和低密度脂蛋白影响血浆sdLDL水平（P〈0.05）。Logistic回归分析结果显示,sdLDL/LDL〉50%者发生缺血性脑梗死的危险性增加（OR值=3.7,95%可信区间2.672～5.214,P〈0.001）;sdLDL异常与腔隙性脑梗死和脑出血的关系无统计学意义（P〉0.05）。结论 sdLDL水平与缺血性脑梗死的发生密切相关,可能是缺血性脑梗死的独立危险因素。

Study on the association of small, dense low-density lipoprotein with stroke

Objective To investigate the relationship between small, dense low - density lipoprotein （sdLDL） , stroke and other risk factors. Methods The plasma level of sdLDL was examined by the automatic analyzer in 112 patients with stroke, including 54 eases of isehemie cerebral infarction （ICI） , 32 eases of lacunar infarction （ LI）, and 26 eases of cerebral hemorrhage （CH） , and in 120 sex and age - matched controls. Traditional risk factors for stroke were investigated as well. The changes of sdLDL in two groups and its relationship with prognosis were observed, multiple stepwise regression method was employed to analyze the influence factors for sdLDL. Results The plasma level of sdLDL was significantly higher in patients with ICI group and LI group （ 1.65 ±0.31 ）mmol/L and （1.13 ± 0.21 ）mmol/L, respectively ] than in the controls （0.39 ±0.14）retool/L, P 〈 0.01 ]. However, the plasma sdLDL of the CH patients was （0.48 ＋ 0.19 ）mmol/L], the difference showed no statistical significance from that of the controls（ P 〉 0.05 ）. Multiple stepwise regression analysis showed that sdLDL was significantly associated with systolic blood pressure, age, and the levels of triglyeeride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol （ P 〈 0.05 ）. Conclusion Multivariate logistic regression analysis showed that those with sdLDL/LDL 〉 50% had increase of risk of isehemie cerebral infarction （ OR = 3.7, 95% CI 2. 672-5. 614, P 〈 0. 001 ） independent of other risk factors. The relationship between sdLDL abnormality and LI and between sdLDL abnormality and SH had no statistical significance （ P 〉 0.05 ）. Conclusion sdLDL is significantly associated with isebemie eerebral infarction independent of other risk factors.